Emergency Information

Emergency Contact 1*

First NameLast Name

Cell Phone Number*

Area CodePhone Number

Emergency Contact 2*

First NameLast Name

Cell Phone Number*

Area CodePhone Number

Additional Info

TERMS & CONDITIONS

PARENTAL CONSENT: I hereby give consent for my child to participate in all activities of Chabad Hebrew School (CHS) both on and off site, including trips, transportation to and from trips etc., unless I advise you otherwise in writing. MEDICALCARE: In case of emergency, I hereby give permission to the physician selected by the school director, to hospitalize, to secure proper treatment for and to order injection, anesthesia, or other procedure deemed necessary for my child by an MD. Every effort will be made to contact the Parent / Legal Guardian and emergency contacts first. Should it be necessary for the wellbeing of the student to utilize outside medical or dental services, all expenses involved will be paid for by the parent. To the best of my knowledge, my child is in good health and I will notify the school if he/she is exposed to any infectious diseases. I understand that my child may be dismissed during a school day, due to illness, at the discretion of the school, and I agree to abide by the Director’s decision. IMAGES, ETC.: Permission is hereby given to use in promoting the School and in other ventures directly relating to the School (I) digital, photographic and video images or likenesses of student; audio of student; and (II) statements, articles, names, music, art, photographs, audio recordings, films and videos created by student or originating from School or from a school-related activity. INDEMNIFY & HOLD HARMLESS: I further release and agree to indemnify and hold harmless Chabad Hebrew School (CHS) and its officers, servants or assigns from any liability or claim for any loss, injury, damage or expense resulting or arising from my child’s participation in camp activities. I further agree that the use of any premises during the CHS School day is made at the risk of the registrant.

In addition, I acknowledge that the CHS administration reserves the right to reconsider the enrollment of any camper if we feel the child’s needs or level of functioning or behavior cannot be accommodated, or if the child’s conduct limits his or her ability to participate in, or to benefit fully from, the program and activities at CHS. In addition, I acknowledge that I have read and accept the financial obligations and the refund policy as stated in the application form.

I Accept*

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Full Name*

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Payment Information

$50 Registration Fee

Early Bird Discount Prior to 8/1/19: $750 | Chai Club Members**: $675

After 8/1/19: $800 | Chai Club Members: $720

Scholarships are available. All Scholarship requests MUST be submitted before August 15th 2019. Click Here for the Scholarship Application Form.